Systems and methods for performing spinal surgery

ABSTRACT

A revision instrument for positioning and securing an intervertebral implant in an intervertebral space between vertebrae is provided. The revision instrument includes a shaft having a body extending from a first end to a second end. A first port and a second port extend through the body of the shaft and a connection tool having a first end and second end is positioned within the first port. The connection tool extends through the first end of the shaft through the second end of the shaft. The first end of the connection tool includes a mating feature configured to couple with an expandable implant and the second end of the connection tool includes a rotation feature configured to rotate the connection tool to engage or disengage the connection tool with the expandable implant. The second port is configured to receive an expansion driver for expanding or compressing the expandable implant.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 16/289,395, filed on Feb. 28, 2019, which isnon-provisional application which claims priority to provisionalapplication Ser. No. 62/636,216 filed on Feb. 28, 2018, which isincorporated in its entirety herein.

FIELD OF THE INVENTION

The present disclosure provides an instrument for more efficientlyperforming spinal surgery using expandable intervertebral implants.

BACKGROUND OF THE INVENTION

The vertebrate spine is the axis of the skeleton providing structuralsupport for the other parts of the body. Adjacent vertebrae of the spineare supported by an intervertebral disc, which serves as a mechanicalcushion permitting controlled motion between vertebral segments of theaxial skeleton.

The spinal disc can be displaced or damaged due to trauma, disease,degenerative defects or wear over an extended period of time. Toalleviate back pain caused by disc herniation or degeneration, the disccan be removed and replaced by an implant that promotes fusion of theremaining bone anatomy. The implant, such as a spacer or cage body,should be sufficiently strong to support the spine under a wide range ofloading conditions. There remains a need for improved instrumentationthat facilitate intervertebral fusion and serve as a means to restoreintervertebral height and/or lordosis. Specifically, there is a need forinstrumentation that allows for surgeons to control and manipulate anexpandable implant throughout the entire procedure, regardless ofpatient positioning.

SUMMARY OF THE INVENTION

To meet this and other needs, intervertebral implants, instrumentssystems, and methods are provided. In one embodiment, a revisioninstrument for positioning and securing an intervertebral implant in anintervertebral space between vertebrae is provided. The revisioninstrument includes a shaft having a body extending from a first end toa second end. A first port and a second port extend through the body ofthe shaft and a connection tool having a first end and second end ispositioned within the first port. The connection tool extends throughthe first end of the shaft through the second end of the shaft. Thefirst end of the connection tool includes a mating feature configured tocouple with an expandable implant and the second end of the connectiontool includes a rotation feature configured to rotate the connectiontool to engage or disengage the connection tool with the expandableimplant. The second port is configured to receive an expansion driverfor expanding or compressing the expandable implant.

In another embodiment, the present disclosure provides a spinal implantsystem for stabilizing adjacent vertebral bodies. The system includes anexpandable implant and at least four pedicle screws, each of the atleast four pedicle screws having a housing and configured to bepositioned within the pedicle of the spine. The system includes at leasttwo rods configured to be positioned within the housing of the pediclescrews. A revision instrument is also provided with includes a shafthaving a body extending from a first end to a second end. A first portand a second port extending through the body of the shaft and aconnection tool having a first end and second end positioned within thefirst port, the connection tool extends through the first end of theshaft through the second end of the shaft. The first end of theconnection tool includes a mating feature configured to couple with anexpandable implant and the second end of the connection tool includes arotation feature configured to rotate the connection tool to engage ordisengage the connection tool with the expandable implant. The secondport is configured to receive an expansion driver for expanding orcompressing the expandable implant.

In another embodiment, there is provided a method for stabilizing thespine of a patient that include the steps of providing an expandableimplant and positioning the expandable implant in a disc space betweenadjacent vertebral bodies. The method also includes expanding theexpandable implant to a first height within the disc space and attachinga revision instrument to the expandable implant and then securing therevision instrument to the patient. The method further includestransitioning the patient from a first position to a second position andpositioning pedicle screws and rods in the posterior spine of thepatient, engaging the revision instrument with an expansion driver toexpand or compress the expandable implanter, securing and locking thepedicle screws and rods and removing the revision instrument from thepatient.

BRIEF DESCRIPTION OF THE INVENTION

A more complete understanding of the present disclosure, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings wherein:

FIG. 1A is a top view of a revision instrument for performing spinalsurgery using an expandable intervertebral implant;

FIG. 1B is a side view of a revision instrument for performing spinalsurgery using an expandable intervertebral implant;

FIGS. 1C and 1D are a front view and a rear view of the revisioninstrument for performing spinal surgery using an expandableintervertebral implant;

FIG. 2 illustrates the device of FIG. 1 attached to an expandableimplant in one exemplary embodiment;

FIG. 3 is a top view of the revision instrument attached to anexpandable implant;

FIG. 4 is a side view of the revision instrument attached to theexpandable implant shown in FIG. 3;

FIG. 5 illustrates the assembly of FIG. 2 in use with an expansiondriver tool;

FIG. 6 illustrates a lateral view of an expandable implant positionedbetween adjacent vertebral bodies and posterior fixation implants;

FIG. 7 illustrates the expandable implant coupled to the revisioninstrument for use in expanding the expandable implant; and

FIG. 8 illustrates an anterior view of the expandable implant coupled tothe instrument.

DETAILED DESCRIPTION OF THE INVENTION

It is to be understood that the present disclosure is not limited in itsapplication to the details of construction and the arrangement ofcomponents set forth in the description herein or illustrated in thedrawings. The teachings of the present disclosure may be used andpracticed in other embodiments and practiced or carried out in variousways. Also, it is to be understood that the phraseology and terminologyused herein is for the purpose of description and should not be regardedas limiting. The use of “including,” “comprising,” or “having” andvariations thereof herein is meant to encompass the items listedthereafter and equivalents thereof as well as additional items. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled” and variations thereof are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings.

The following discussion is presented to enable a person skilled in theart to make and use embodiments of the present disclosure. Variousmodifications to the illustrated embodiments will be readily apparent tothose skilled in the art, and the principles herein can be applied toother embodiments and applications without departing from embodiments ofthe present disclosure. Thus, the embodiments are not intended to belimited to embodiments shown, but are to be accorded the widest scopeconsistent with the principles and features disclosed herein. Thefollowing detailed description is to be read with reference to thefigures, in which like elements in different figures have like referencenumerals. The figures, which are not necessarily to scale, depictselected embodiments and are not intended to limit the scope of theembodiments. Skilled artisans will recognize the examples providedherein have many useful alternatives and fall within the scope of theembodiments.

FIGS. 1A, 1B, 1C, and 1D illustrate a revision instrument 10 accordingto one exemplary embodiment of the invention. The revision instrument 10for positioning and securing an intervertebral implant in anintervertebral space between vertebrae is provided. The revisioninstrument 10 includes a shaft 12 having a body extending from a firstend to a second end. A first port 14 and a second port 16 extend throughthe body of the shaft and a connection tool 18 having a first end 22 andsecond end 20 is positioned within the first port 14. The connectiontool 18 extends through the first end of the shaft through the secondend of the shaft. The first end 22 of the connection tool includes amating feature 24 configured to couple with an expandable implant andthe second end of the connection tool 18 includes a rotation feature 26configured to rotate the connection tool 18 to engage or disengage theconnection tool 18 with the expandable implant. The second port 16 isconfigured to receive an expansion driver for expanding or compressingthe expandable implant.

Now turning to FIGS. 2, 3, and 4, the revision instrument 10 coupled toan expandable implant 30 is illustrated. FIG. 2 illustrates aperspective view of the revision instrument 10 and the expandableimplant 30, which is in an expanded state. FIG. 3 illustrates a top viewof the revision instrument 10 attached to the expandable implant 30 andFIG. 4 illustrates a side view of the revision instrument 10 attached tothe unexpanded expandable implant 30.

FIG. 5 illustrates the revision instrument 10 coupled to the expandableimplant 30 and an expansion driver instrument 32. The expansion driverinstrument 32 is used to either expand or collapse the expandableimplant. The expansion driver instrument 32 is positioned through thesecond port of the revision instrument 10. The connection tool 18 ispositioned through the first port of the revision instrument 10.

Now turning to FIGS. 6, 7, and 8, the operation of the revisioninstrument with the expandable implant will be described in more detail.FIGS. 6, 7, and 8 illustrates an expandable implant 30 positioned withinthe intervertebral disc space. Also shown in FIG. 6 is posteriorinstrumentation that secures the mobility of the spinal segment. Theposterior instrumentation includes pedicle screws 32 and rod 34 used tostabilize the posterior elements of the spine. During a spinal procedureto restore disc height and lordosis in the spine, surgeons may utilizethe expandable implant 30 that may be inserted from a lateral approachto restore disc height and lordosis in a controlled manner. It should benoted that although a lateral implant is disclosed, anterior orposterior lateral expandable implants may also be used in the connectionwith the instrument of the present application. In these spinalprocedures, the expandable implant 30 is positioned and then expandeduntil a maximum optimal height is reached or until a maximum inputtorque is applied. Factors that can limit the expansion of the implant30 can include the mobility of the facet joints, excess disc material,and calcified ligaments. Once the expandable implant 30 is positionedbetween adjacent vertebral bodies, the patient is rotated to a positionin which pedicle screws 32 and rod 34 may be placed to compress theinstrumented segment in order to restore lordosis as shown in FIG. 6. Itshould be noted that although a single expandable implant isillustrated, additional expandable implants may be positioned inadjacent levels of the spine. As the spine is manipulated either throughthe positioning of additional interbody implants, posteriorinstrumentation (such as pedicle screws and rods), or repositioning onthe surgical table, it may become necessary to adjust the expandableimplant to compensate for increased mobility of the motion segments ofthe spine by utilizing the revision instrument 10.

As illustrated in FIGS. 6, 7, and 8, the revision instrument 10 may beused for additional expansion and/or adjustment of the interbodyexpandable implants at subsequent points in the procedure. The revisioninstrument 10 as discussed with reference to FIGS. 1-5, is positionedand retained to the expandable implant 20 in the surgical site andsecured to the skin to allow for the patient to be repositioned and/oradditional instrumentation to be placed. The revision instrument 10would allow for the passing of the expansion driver tool 32 in order tomanipulate the expandable implant 30 after additional interbody devicesand/or posterior instrumentation are positioned in the posteriorelements of the spine. The expandable implant 30 may then be adjusted tocompensate for correction beyond that achieved from the initial patientpositioning and expandable implant placement. The revision instrumentcan be secured to the patient to prevent excess forces on theimplant-to-instrument connection.

In one exemplary embodiment, a method using the revision instrument withan expandable implant 30 as disclosed above is described below. Themethod includes the steps of providing an expandable implant andpositioning the expandable implant in a disc space between adjacentvertebral bodies. The method also includes expanding the expandableimplant to a first height within the disc space and attaching a revisioninstrument to the expandable implant and then securing the revisioninstrument to the patient. The method further includes transitioning thepatient from a first position to a second position and positioningpedicle screws and rods in the posterior spine of the patient, engagingthe revision instrument with an expansion driver to expand or compressthe expandable implanter, securing and locking the pedicle screws androds and removing the revision instrument from the patient.

In another embodiment, if any spondylolisthesis is present, it would bepossible to decrease the expandable implant expansion while the patientis prone to allow for additional correction with posteriorinstrumentation. Once the desired correction of the spine is achieved,the implant can be re-expanded using the auxiliary instrument attachedto the implant.

It will be appreciated by those skilled in the art that while theinvention has been described above in connection with particularembodiments and examples, the invention is not necessarily so limited,and that numerous other embodiments, examples, uses, modifications anddepartures from the embodiments, examples and uses are intended to beencompassed by the claims attached hereto. The entire disclosure of eachpatent and publication cited herein is incorporated by reference, as ifeach such patent or publication were individually incorporated byreference herein. Various features and advantages of the invention areset forth in the following claims.

We claim:
 1. A revision instrument for positioning and securing anintervertebral implant in an intervertebral space between vertebrae, therevision instrument comprising: a shaft having a body extending from afirst end to a second end; a first port and a second port extendingthrough the body of the shaft; a connection tool having a first end andsecond end positioned within the first port, the connection toolextending through the first end of the shaft through the second end ofthe shaft; wherein the first end of the connection tool includes amating feature configured to couple with an expandable implant and thesecond end of the connection tool includes a rotation feature configuredto rotate the connection tool to engage or disengage the connection toolwith the expandable implant, wherein the second port is configured toreceive an expansion driver for expanding or compressing the expandableimplant.
 2. The revision instrument of claim 1, wherein the matingfeature of the connection tool is threaded features.
 3. The revisioninstrument of claim 1, wherein the mating feature of the connection toolis a dovetail connection.
 4. The revision instrument of claim 1,includes a third port for receiving an instrument to deliver graftmaterial to the expandable implant.
 5. The revision instrument of claim1, wherein the second port is configured to receive an instrument todeliver graft material to the expandable implant.
 6. The revisioninstrument of claim 1, wherein the revision instrument is secured to theexpandable implant and removed only after positioning the pedicle screwswithin the pedicle of the spine.
 7. A spinal implant system forstabilizing adjacent vertebral bodies comprising: an expandable implant;at least four pedicle screws, each at the at least four pedicle screwshaving a housing and configured to be positioned within the pedicle ofthe spine; at least two rods configured to be positioned within thehousing of the pedicle screws; a revision instrument having a shafthaving a body extending from a first end to a second end; a first portand a second port extending through the body of the shaft; a connectiontool having a first end and second end positioned within the first port,the connection tool extending through the first end of the shaft throughthe second end of the shaft; wherein the first end of the connectiontool includes a mating feature configured to couple with an expandableimplant and the second end of the connection tool includes a rotationfeature configured to rotate the connection tool to engage or disengagethe connection tool with the expandable implant, wherein the second portis configured to receive an expansion driver for expanding orcompressing the expandable implant.
 8. A revision instrument forpositioning and securing an intervertebral implant in an intervertebralspace between vertebrae, the revision instrument comprising: a shafthaving a body extending from a first end to a second end; a first portand a second port extending through the body of the shaft; a connectiontool having a first end and second end positioned within the first port,the connection tool extending through the first end of the shaft throughthe second end of the shaft; wherein the first end of the connectiontool includes a mating feature configured to couple with an expandableimplant and the second end of the connection tool includes a rotationfeature configured to rotate the connection tool to engage or disengagethe connection tool with the expandable implant, wherein the second portis configured to receive an expansion driver for expanding orcompressing the expandable implant, wherein expandable implant restoresdisc height and lordosis in the spine, and wherein the revisioninstrument is positioned and retained to the expandable implant in asurgical site and secured to the skin to allow for a patient to berepositioned.